Request a Professional Account

Register to sign-up for in-office sampling, in-office sales and Skinfix educational materials. Please note it will take us 2-3 business days to verify your account. If you have any questions, please email us at dermsampling@skinfix.com.

Dermatologist Information

Title

First Name^*

Last Name^*

Professional Office Name

Email Address^*

Phone Number

Office Manager Information

Title

First Name

Last Name

Professional Office Address

Street Address

Address Line 2

City

State

Postal/Zip Code

Country (US or Canada)

Please accept the terms below

I have read and accept the general terms and conditions. I am requesting access to purchase products and I certify that I have authorization to do so for this account.
Yes, I accept those conditions^*.